Thyroid Gland Solitary Fibrous Tumor: Report of 3 Cases and a Comprehensive Review of the Literature

Abstract

Solitary fibrous tumors of the thyroid gland are exceptionally rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, three cases of thyroid gland solitary fibrous tumor were analyzed in conjunction with 35 cases compiled from the English literature. Thyroid gland solitary fibrous tumors showed an equal sex distribution with a mean age at presentation of 54.4 years (range, 28-88 years). The patients typically presented with an asymptomatic, slow growing neck mass. Microscopically, the tumors were characterized by cytologically bland spindle cells with patternless growth, hypocellular and hypercellular areas, variable amounts of collagen, and ectatic, branching blood vessels. Two previous reported tumors were considered to be histologically malignant on the basis of increased mitotic activity, profound pleomorphism and tumor necrosis. Immunohistochemically, the tumor cells are variably positive with CD34, bcl-2, and CD99. STAT6 immunohistochemistry, performed on the current cases, demonstrated a strong, diffuse nuclear expression in all tumors. Among 26 patients with available follow up data (mean 47.3 months), one developed local recurrence and distant metastasis. Solitary fibrous tumors occurring in the thyroid gland are uncommon, but can be reliably diagnosed based on the presence of characteristic morphologic features as well as immunohistochemical expression of STAT6 and CD34. The majority of thyroid gland solitary fibrous tumors have exhibited an indolent clinical course, however experience is limited. The rare potential for aggressive clinical behavior requires clinical surveillance.

Keywords: Follow-up studies; Immunohistochemistry; Neoplasms, vascular tissue; STAT6; Solitary fibrous tumors; Thyroid gland.

Fig. 1

Low power of a thyroid gland solitary fibrous tumor composed of spindled cells dissecting between thyroid gland follicles

Fig. 2

This solitary fibrous tumor is quite cystic, with easily identified colloid between the spindled cells

Fig. 3

The cellularity of thyroid gland solitary fibrous tumor is quite variable: a Thyroid gland follicles are noted admixed with the spindled cells. b A storiform pattern is present in this tumor. c The spindled cells are quite short in this tumor, with easily identified vessels. d This tumor is hypocellular, with more abundant collagen identified. Patulous vessels are present

Fig. 4

The neoplastic cells show a strong and diffuse reaction with a CD34 (cytoplasmic), b bcl-2 (cytoplasmic), and c STAT6 (nuclear)